Book Reviews

When a prestigious world-class university such as Harvard dismally fails to provide its undergraduates a worldview to help shape responsibly their future insofar as they can best fit within their country and the world at large or do the utmost they can accomplish, then such a university is soulless. This universal is the thesis of Lewis’s controversial book, hence the title and its qualifying adverbial phrase.

carriage; from fwallowing, fpeaking, coughing, or ltraining at flool; and fometimes alfo they attack the patient from about two to four o'clock in the morning, or while fitting or ftanding, without any previous exertion or obvious caufe. The paroxyfms now alfo become more violent, and do not fo readily recede. During the fit, the pulfe links in a greater degree; the face and extremities become pale, and bathed in a cold fweat, and for a while, perhaps, the patient is deprived of the powers of fenfe and voluntary motion. At length, after the difeafe has recurred more or lets frequently, fometimes during a fpace of many years, which admit of the patient's death from a variety of other caufes, a more violent attack, of the nature which I have juft defcribed, puts a fudden period to his exiftence. " Thefe are the eflential fymptoms and more obvious caufes of the unmixed Angina Pe&oris. " To this we may add, that the Angina Pedloris is in no ftage attended with inflammatory fever, and that both its termination, and the appearances, on difledtion, of thofe who die of it, are totally different from thofe related in the paper (to which I refer) in the London Medical Tranfadtions. " Equally diffimilar alfo to the difeafe which I have defcribed are thofe three cafes by Drs. Macbride and Smith, of Dublin, in the fifth volume of the Edinburgh Medical Commentaries. They are evidently cafes of palpitation of the heart, fuch as every phyfician of extenfive practice muft have often feen. In almoft every violent cafe of this kind, there is a pain of the cheft and elbows, as in the true Angina Pedloris. Nor is it difficult to underftand how a rapid and irregular tranfmiffion of blood through the carotid and pulmonary arteries fhould produce that laborious refpiratioq, turgefcence and rednefs of the face and eyes, and head-ach, v.
' which V / Dr. Parry, on Syncope Anginofa. 477 which are mentioned in the cafes referred to. In the true Angina Pectoris, on the contrary, as we have feen above, there is neither dyfpncea nor palpitation of the heart. " From. the detail which I have given, it appears that there have been publilhed not more than ten ellays relative to the true Angina Peftoris, containing only as many detailed cafes, and nine directions of perfons dying of that diforder. " We cannot wonder that an experience fo contracted lhould have left fome fymptoms of the difeafe unnoticed, and much uncertainty with regard to the diftin&ions and pathology. Thefe deficiencies, I trull, will be in part fupplied by the cafes which I have related* " In Mr. Bellamy, the Angina Pedloris appears to have been much complicated with another diforder, from which its fymptoms are fcareely feparable ; but the two laft cafes are by far the molt limple of any which have been detailed. They had medical affiftance the fooneft after the commencement of the paroxyfm, and proved fatal after the fmalleft number of attacks. Mr. $?*#* may be almolt faid to have twice died; fo that^he circumftances accompanying the fatal termination were capable of being afcertained in the molt exaft manner. " He had the common fymptom of a pain affe&ing the fternum, and extending from thence acrofs the lower part of the left mamma, firft into the infide of the left elbow, and afterwards of the right elbow. This pain was relieved by eru&ations. He had no dyfpnoea, or palpitation of the heart. His pulfe was weak and fmall; and had, at long intervals, an occafional imperfect ftroke. Thefe fymptoms have already been mentioned by authors as generally occurring. The following circumltances I cannot any where find defcribed: ' " My patient's diforder was increafed by bending the trunk of the body forwards; and it was probably from fome re*ief which he experienced that he was fond not only of ftraitening the fpine, with the head fomewhat reclined backwards, but alfo of ftretching out his ?rms in the pofture of yawning. He fighed frequently, and feemed to take great pleafure in refting on a full infpiration, which afforded a momentary relief to the uneafy fenfation in his , reaft. Is it poflible that this fymptom, which is not remarked by any of the writers on the Angina Pectoris, was wanting in thofe cafes which fell under their notice ? I am difpofed to think that it was not; becaufe it has been very obfervable in feveral examples which I have known of patients labouring under this difeafe j and my learned friend, Dr. Falconer, with whom, I have converfed on this fubjed-, alfures me, that it was particularly remarkable in two initances which were, fome years ago under his care, nearly at the iame time, and which ended in fudden'death. I. Syncope {cardiaca.) Ex. 'vitio cordis, <vel <vaforum <vicinorum. " a. Anginofa. A corporis motu inter ambulandum faspe oriensj praseunte anguftia, vel dolore, pedtoris notabili, per mammam fi-Jiiftram praeciipu'e porredto ; fine cordis palpitatione. " Angina Pectoris Audlorum. " b. Palpitans. Sine caufa manifefta fcepe rediens, cum palpitatione cordis vehementi in intervallis.
" Befide fome other changes in Dr. Cullen's original claflification, I have, in this new arrangement, inferted the Syncope Anginofa as a variety of the Syncope Cardiaca; and I have given the trivial name palpitans to that arifing from the more common difeafes of the heart, becaufe the latter is ufually attended with palpitation, which I have marked as wanting in the former." Chap. IV. p. 70, is entitled, " Caufes of Syncope in general. ?Diffedtions.?Predifpofing Caufes.?Exciting Caufes.?Caufes of Syncope Anginofa,?Difeafed Coronary Arteries of the Heart." But it is unnecefiary for us to give any farther extradts from this work, as we are convinced that every medical pradtitioner will fpeedily and carefully perufe the original. Vhe Anatomy of the Gravid Uterus, with practical Inferences relative to Pregnancy and Labour. By Jo-hn Burns, Surgeon, Glafgow, 8vo. pp. 248. price 5s. in boards. London, Johnfon. We have no hefitation in recommending this work to our readers. In the Introdudtion the author juftly infills on the neceflity of an accurate anatomical knowledge of the gravid uterus, as the foundation of the art of midwifery; and truly obferves, that, " He who his 'ignorant of this fubjedt, can only pradtife with impunity Jn thofe cafes where the affiftance of art is ufelefs; and even' here, he is only fafe whillt he remains a mere fpe&ator." But the author does not confine his obfervations folely to the anatomy of the uterus ; the reader will find confiderable attention has been paid to the pathology of this organ, and alfo feveral important pradtical directions are given on the diforders attendant on pregnancy, as well as on adlual labour and its confequences.
On the fubjedl of flooding occurring about the feventh month, and which takes place from the attachment of thf placenta over \ ?
|JlQ Mr. Burns, On the Anatomy of the Gravid Uterus. 479 * the os uteri, we {hall give the author's own words, as they are an epitome of the beft modern practice. " When flooding depends upon this caufe, venefe&ion, cold, and the ufual remedies, may moderate or check it for a time ;vbut the only radical cure is delivery. This, however, is at firft difficult, or impoffiBle to be accomplifhed, from the tightnefs of the vagina, and the firmnefs of the os uteri. The bell practice, therefore, is, to reftrain the hemorrhage, by cold applications, or a plug, until the parts will more readily admit of diftenfion. Until this can be done, the danger is not great, becaufe, as long as the os uteri is firm and fmall, the bleeding is, comparatively fpeaking, inconfiderable.
In this fpecies of flooding, the quantity of blood which is loll marks the progrefs of labour, or the degree of dilatation; and whenever the flow is fo great as to demand oar immediate interference, we may be certain that delivery can readily be accomplifhed. The danger of the cafe, from immediate lofs of blood, .and the eafe with which we can operate, are exattly proportioned ,to each other. The propriety, therefore, of not interfering ma-" nually too foon, will readily appear; becaufe, at firft, we may, by cold and plugs, moderate the haemorrhage, until the parts admit of delivery; whilft we (hould inevitably increafe the difcharge, by beginning our operation prematurely, at the fame time that we did not, by this condutt, gain one fingle advantage. " We then introduce the fingers, to dilate the os uteri, and either feparate the placenta, or pufh our hand through its fubftance. Pufliing the hand through the placenta is by no means fo advifeable as feparating it, where this can be done ; becaufe the placenta, when attached over jhe os uteri, is generally lefs in circumference, and greater in thicknefs, than when attached at the fundus. We have, therefore, a great number Or cells or veflels to tear, and find it difficult to pull the child through the mangled placenta, which will continually interrupt us in our operation.
" After which, we lay hold of the feet, and deliver flowly. I fay flowly, becaufe precipitation is ufelefs, as well as dangerous, 1 the body of the child afting as a plug, and reftraining the bleeding.
-" Delivery then, is the only chance of fafety* and this we begin as foon as the ftate of the parts will permit us. Evacuation of the waters, which is ufeful in other fpecies of flooding, is ufelefs here, and ought never to "be procured, unlefs as preparatory to delivery, when we are ready to perform it. The neceflary preclude to this evacuation, namely, the feparation or piercing of the placenta, muft increafe the difcharge, inftead of abating it." We would recommend to fome of our The author's celebrity, and the importance of the fubjefts treated of in this ^vvork, will not fail to procure it readers. We cannot prefent a better account of^ the contents of this performance, than that given by the author in the Conclufion. " THE origin, progrefs, improvements, and treatment of every fpsfiies of venereal infedtion have been difcufled, as far as this performance admitted. Animadverfions on deftrudtive principles and pradtice, new or old revived chimerical projedts, have been profufely introduced. Antivenereal remedies, whether openly avowed and regular, or fecret and irregular, have been examined and criticifed. The reafons for never treating any venereal infedtion. with* out mercury, and the neceffity of banifhing powerful falivatiOns, are fubmitted to the confideration of the learned and experienced in the medical profeliion: they are founded in reiterated obfervation, and admitted by the moll: able pradlitioners in Europe. The merits of mild fuccefsful practices, and the additional force of mineral alteratives in complex venereal cafes, according to circumlVances, conftitutions, feafons, and climates, are energetically inculcated.
Many original and appropriate prefcriptions have been communicated, for the different purpofes of pradtice in the variety of circumftances that occur. The fuperior utility of fumigations, and of many methods of treatment, has been defended, , which fleeting whimfical hypothecs, or which inexperience or preemption, had rafhly decried, without any pradtical knowledge of their importance. Aftringent injedtions have been demonftrably proved the principal'caufe of urethral obftrudtions and ftridture. Mild methods of treating fuch cafes, with fafety and fuccefs, have been ardently recommended and fully authenticated. Cauftic bougies, applied to the urethra under pretence of removing ttridtures, have been ftiown not only inadequate to their intentions, but often dreadfully deftrudtive in their'confequences. When radical cures have been confidently promifed by the caufticators, and Credited with the warmefl hopes and expectations by the deluded patients, additional mifery, permanent fufferings, or a dreadful death, have been too often the confequences of the tormenting delufion. The methods of alleviating the horrid iniferies, which cauliics produce when applied to the exquifitely fenfible uretTira, are laftly introduced, and many caufes of impotence from -urethral complaints explained. The whole work is interfperfed with fentiments and rpfledtions on many defedts of the art, and' what appeared the moft eifedtaal means of their removal, by a learned and pradtical education, fuch as Boerhaave, Hoffman, Heilter, and other diftinguilhed phyficians and furgeons have ^offeffecl and inculcated. Thefe . 1 dodtrines ' Dr. Rowley's Cogent "Reafons^ &<, 4$* do&rines are chiefly intended for the ferious perofal and contemplation of ftudents; and the inexperienced, and all who have been deluded by thofeN and other late chimerical fallacies, which haw urged the neceffity of the prefent animadverfions. " Having now difcharged a duty to the profeflion," and to the public, from whom, through a long life, fo much confidence and prOte&ion have been experienced, a ihort paufe may be requifite.? An apology may be thought expedient.?An apology ftiould be offered for the free cenfures advanced ; the frequent repetitions of which, to fome readers, may prove difguftful. To the learned and. well-informed, many parts may be thought redundant; but to thofe who are inexperienced, and have yet their profeffion to learn, a work cannot be too explicit or inftruftive. There appeared but two modes of procedure on the prefent occafion ; either filently to {uffer a continuance of dreadful injuries to fociety, Or to openly cxpofe their evil tendency. The former would have been pufillafoimous and iniquitous; the latter, therefore, has been adopted, in order to reform fome of thofe ferious abufes, that have been revived or forced into the art with mOre fpecioufnefs and rafhqefs than truth. " As the evils of urethral ftri&ures muft occur fo long as the effects of aftringent injections, or other mal-practices continue; let not the cruel violent modes of burning the moll fufceptible parts of man be adopted for their removal.* " It may be expelled that this work, however dictated by humanity, muft produce private enemies, who will fecretly whifper .what they dare not openly avow. A man accuftomed to the detraction of malevolence for public benefits has little to apprehend ; but mankind fhould be warned how they receive calumniating infinuations inftead of truth. In this liberal fcience let not the proverb be applied, figulus figulum odit, medicus medicum. However events may happen, it can only be faid, that, unlefs provoked, many additional proofs of the mifchievous tendency of the cenfured do&rines {hall ever be fupprefled; but if forced, by any defence of the practice, they fhall appear in all their hideous colours." THIS volume is'divided into four Se&ions. The firft, which occupies about half the volume, contains an analyfis of books ; and of thofe publifhed in England we have already given an account in our preceding numbers ; of the foreign articles, an analyfis will be given as foon as poflible.

Annals of
s The fecond fection is intitled Medical Ohfernjations, comprifing original communications of cafes, and their treatment; fome of which are referred to in the prefent f and preceding J numbers of this Journal.
The fecond, in the order they are publifhed, is a Cafe of Uterine Hemorrhage, ivhere the.Placenta ivas expelled four hours before the Birth of the Child. By Mr. John Chapman, Surgeon, at Ampthill. As there is fomething uncommon in this cafe, we fliall prefent our readers with an abftratt of it. " Upon my fecond examination," fays the author, " I difcovered the head, as before, with an edge of the placenta beginning to protrude * A diftinguifhed nobleman was faid to be perfectly cured by the burning cauftic? pus, fanies, and different coloured matter is daily voided with the urine, with additional callofities in moft parts of the urethra.
Such are the pretended cures, many inftances of which I have feen. A fervant of the fame tiobleman loft his life by the cauftic..?Whilft I am writing this, a clergyman is prefent, who unhappily had the cauftic repeatedly applied, in the courfe of two or three years; the original cauf? of his ft rift ure was the application of aftringent injections, when a youth at Eton. The ufe of cauftic has rendered him truly roiferabley who was but (lightly fo before.

4.83
trude through the os 'uteri, with a very trifling hemorrhage. This ?was incr, afed upon the return of the pains, but was fo inconfiderable, as not to be direftly alarming. I therefore did not conceive myfelf juftified at this ftage in proceeding to immediate delivery; but as, upon every return of pain, the placenta became more and more protruded through the os uteri; and as it Was now entirely detached, without the head in the leaft advancing, and the hemorrhage being fomewhat more increafed, I informed her of her fituation, and the neceflity there might be for immediate delivery, if the hemorrhage increafed: Finding it would be with very great reludtance fhe would agree to this, I requefted my worthy friend, the late Mr. Humberftone, (the gentleman I then aflifted), might be fent for. Previous to his arrival, the pains continued fo ftrong, that the os uteri became dilated, and the placenta was completely expelled through the os externum: this happened about three o'clock on Monday morning, and with very little hemorrhage; but from this moment the pains entirely ceafed. I would now have proceeded to delivery, but it was objected to, becaule fhe had not any pains J that fhe had plenty of ftrength; and that they hoped there would not be any impropriety in waiting the arrival of Mr. H^who was every moment expected: I agreed, if no hemorrhage happened in the mean time. He did not arrive until five o'clock. There had not been the leaft haemorrhage fince the expulfion of the placenta.
We now concluded, as the pains had entirely fubfided, much was to be feared, and nothing could be gained, by delaying delivery iny longer. If we were to wait the return of pains, the hemorrhage might return, and we fhould be brought to that point of time when we mult be obliged to deliver; and fhe would moft probably die under the operation. Having great ftrength and fpirits, the neceflity of turning was properly reprefented to her; and the danger that might accrue from any farther delay. She now fubmitted, and the parts being perfectly well dilated, Mr. H. introduced his hand, with little difficulty, into the uterus; but with all his efforts, for upwards of half an hour, he could not recover a foot. I then made anyattempt, and introduced my hand readily into the uterus, and found it fpafmodically contracted, in a longitudinal dire&ion; the circular fibres atting without the confent of the longitudinal. I proceeded with the greateft degree of caution, adting betwixt the pains, (which our efforts had now excited); but every effort to introduce my hand farther towards the fundus uteri, where the feet evidently lay, increafed the fpafmodic contraction, that with all my efforts for nearly an hour, I gained nothing, and defifted. During the whole of this time, the hemorrhage had not in the leaft increafed. Our efforts to turn being thus fruftrated, we thought that, by bringing down the hand, the head might be brought fufficiently low in the pelvis, (being a large pelvis, and only an eight month's foetus), as to come within the grafp of the forceps, refblving to apply them higher than would be admiflible in almoft any other cafe. The forceps were then fent for; but in the interim, was propofe4 by Mr, H. to give a dofe of tintt. qpii, to-take off ' * 1 .
?' ' this 4S4 Duncans* Annals of Medicine far 1799. this preternatural aftion of the uterus. ' I obje&ed to it, as we could not fay,' Go. fo far, and no farther; and if it Ihould fb far take off the adtion of the uterus, and the haemorrhage return, we fhould moft probably lofe our patient. However, 1 confented to twelve dsops only being given.. In a very Ihort time, flie became eafy and comfortable. In lefs than half an hour, the natural pains returned; fo that fix or feven pains expelled the child entirely by the efforts of the mother, the head aud arm prefenting. -Nothing remarkable happened in her recovery, except in about ten days, fhp buffered triflingly from the fwelled leg, (which has been fo well d^feribed by Mr. White). I muft deviate from my fubjeit, to 'Ofbferve, that it is the opinion ,of fome very'refpe&able men, that this never affe&s the fame patient more than once; but this woman had the fame affe&ion of the kg in her fir 11 labour. " REMARKS.
*' iff, What I wifh to call the attention to in the above cafe is, that, notwithftanding the placenta was nearly three hours from the $rft protufion through the. os uteri to its complete expulfion through the os externum, Ihe loft very little more blood than women usually do when the placenta is expelled after the birth of the child. " 2dly, From the expulfion of the placenta to the birth of the child, was full four fours. She loft little or no blood. How far.
does this fuggeft a different prattice, (to that in general followed), I mean, of delivering the placenta previous to delivering the child, in thofe cafes of alarming hemorrhage, where the placenta is fituated on the fide of, or over the os uteri ? " jdly, The very fingular and fudden effect produced by fo fmall a dofe of tinft. opii, in removing the fpafmodic contraction of the uterus, fuggefts to us a moft excellent remedy on thefe ?ccafions.'* The following extract from page 492, &c. is given in order to illuftrate the communications of Drs. Trotter and Yeats, on Nitrous Fumigation, in this and the preceding number. In a letter to Dr. Duncan, Dr. Yeats fays: " In turning over the pages of the laft volume of Annals of Me~ dicine, I find another teftimony in favour of Dr. C. Smyth's, plan for deftroying contagion. As a further proof of this, I can add, that it was fuccefsful in arrefting the progrefs of a contagious fever in the jail of this place. Three perfons'were taken ill of a typhous fever, one of whom died. This circumftance reached the ears of a gentleman of great refpe&ability in this neigKbourhood; he ?vras immediately prompted by his well-known humanity, to order further, affiftance, and defired me to attend. Only one perfon was ill of the fever when I went, but he was dangerotifly fo, and the contagion was evidently attacking aapthei*. ^11 the rooms were im-> mediately fumigated with the nitrous vapour. The man ill of the fever Ihewed fymptoma of amendment very fliortly,; and. in the other, Drs. Duncan? Annals of Medicine for 1799-485 ?*her, on whom the typhous, contagion hail commenced its'attack, .no fulther marks of the complaint made their appearance. I fhould have laid no ftrefs upon thef? circumftances, had I not been informed, that many years, ago, a contagious fever appeared in the jail here, and fpread into the tow a, of which feveral died. It appears ,to me, from what I obferved, that had not the nitrous fumigations nipt the contagion in the bud, iomething fimilar might have happened at the prefent time. I beg leave to fubjoin a few remarks on the objections which Dr. Trotter has made to Dr. Smyth's plan. In the Medicrna Nautica, p. 229, Dr. Trottar has obferved, that * J>r. Smyth's Preventive is the very fubftance that every intelligent officer is hourly employed to drive from the decks of his Majefty's fhips. ' Again,p. 230,? In Dr. Smyth's procefs, when the nitrous acid is converted into gas, it lofes a portion of pure air> it is now an elaftic fluid, under the title of nitrons air,or gas. In this Hate it will remain-for fome time, till it again, by a chemical attraction, recover its pure air, when, by its fpecific gravity, it will fall to the deck, nitrous acid.' Were this ftatement correct, the inference no one could deny; but it is not nitrous gas which is difengaged, but concentrated nitric acid in. a fiate of <vepour. In this ftate it has a large quantity of oxygen in its competition. Infleadj therefore., of abftrafting that principle, it will readily part with it, and thus render the atmofphere purer. The fames procured from nitre by the fulphuric acid, are very different in their appearance and qualities from nitrous gas. The forme* is a white vifible vapour, but nitrous gas is invifible; and when fat free, immediately unites with the oxygen of the atmofphere, and forma the orange-coloured nitrous vapour. There is, therefore, a. material difference between the two This miftake, Sir, feems to have efcaped the notice of all who have engaged in this conlroverfy between Dr. Sn.yth and Dr. Trotter. There is no doubt, that the nitrous gas would be extremely prejudicial, but the nitric vapour is certainly ufeful, and poffeffes qualities diametrically oppofite to the nitrous gas. Dr Trotter's objections to'Dr. Smyth's plan, appear to have arifen from his not having a perfectly diftinCt chemical idea of the nature of thefe gafesi. Dr. Trotter pbferves, page 229, * That in proportion tq the quantity azot attracts of oxygen, it is called azot, azotic gas, nitrous gasi nitrous acid, nitric acid.' .. Again,9,'There is no great differetjce_between azotic and nitrous gas.' The miftake here is evident; azot and azotic gas contain no oxygen. This principle is termed limply azot, when freed from its caloric; but when it affumes the aeriform ftate by a combination with the matter of heat, it i? called azotic gas. With xefpeCfc to the difference between azotic and nitrous gas, there is a .very material one. The azotic gas contains no oxygen, and does not readily unite with it, as every one knows who has attempted to form the nitrous acid, by pafling the eleCtric fpark through a jsuxture of azotic and oxygen gafes. Nitrous gas,: on the contrary, ?tt a compound containing, oxygen, and readily uniting with it to fyrm aitroutatid at the temperature of the atmojpfyere. A candid ; Nvmb, XV, Rrr examination examination will convince % mind* fo open to philofophical con*, viftion as Dr. Trotter's, that a mifconception of this kind has led him into errors in his objeftions to Dr. Smyth's plan. The health of his Majefty's naval fubje&s is intimately connetted with the difpute; and I truft, that nothing but a zeal for the improvement of fcience will induce any perfon to attach himfelf to the one or the other fide." I A Letter to 'Thomas Keatt, Efq. Surgeon General to the Army, one of the Surgeons to St. George's Hofpital, &c. ivith fome Remarks on. the Medical ProfeJJion, occajioned by the approaching Ele&ion of a Surgepn to St. George's Hofpital, vacant by the Rejignation of Charles Hawkins, Efq. on the gth of April, 1800, pp. 32.
The purport of this letter is to prove that the Governors at large are not competent judges of the merits of the candidates. The author wifhes fome alteration to be adopted, and " is fure the bufinefs is beft condu&ed by committees, which fhould be elefted annually, at a general meeting of the governors." That the committee of twenty-four profeffional and extra profeffional members, fhould confider the merits of the candidates for any vacant offices, and for thofe of furgeon and phyfician, and be empowered to eleft fficcefTors, who, the author propofes, fhould have more than two-thirds of the whole committee in fheir favour. x